Doctor Name: | LORI A BRODSKY |
NPI Number: | 1164534822 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R047235 |
Business Practice Address: | 175 Us Route 1 Scarborough, ME - 040749048 |
Business Phone Number: | 2078857700 |
Business Fax Number: | 2078857701 |
Mailing Address: | 39 Wallace Ave, SOUTH PORTLAND |
State: | ME |
Postal Code: | 041066143 |
Phone Number: | 2077610650 |
Fax Number: | 2077618198 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R047235 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |